Gadofosveset-Trinatrium-Enhanced MR Angiography and MR Venography in the Diagnosis of Venous Thromboembolic Disease: A Single-Center Cohort Study

Abstract

Background: The aim of this single-center combined prospective/retrospective cohort study was to analyze Gadolinium (Gd)-enhanced MRA (magnetic resonance angiography) and MRV (MR venography) for the diagnosis of pulmonary artery embolism and deep venous thrombosis. The gold standard methods result in major exposure to radiation and a high amount of nephrotoxic iodinated contrast media. This is the first larger contrast-enhanced MR imaging study of acute and chronic venous thromboembolic disease of various stages. Methods: We prospectively examined 88 patients presenting clinical signs of deep vein thrombosis and/or pulmonary artery embolism. A single-session, one-stop shop Gd-enhanced MRA/MRV at 1.5 Tesla, using gradient echo sequences with very short repetition and echo times as well as low flip angles with subtraction and three-dimensional reconstruction, was performed. A diagnosis was made with the consensus of two experienced radiologists. Results: We observed excellent MRA image quality in 87% and even higher diagnostic image quality of MRV in 90% of our examinations. Pulmonary artery embolism occurred with deep vein thrombosis in 22%. Conclusions: Gd-enhanced MRA/MRV provided excellent image quality for the diagnosis of venous thromboembolic disease in the majority of cases. It may be particularly useful to plan and follow-up filter implantation and retrieval in the inferior caval vein.

Gender Differences in Pharmacokinetics: A Perspective on Contrast Agents

“…This gender difference may increase the plasma protein concentrations of gadofosveset and prolong its half-life in women. Serum albumin also has important effects on the relaxivity of gadolinium-containing contrast agents, and differences in albumin levels may change the signal-to-noise ratio of all gadolinium-containing contrast agents. , Of note is that gadofosveset is currently withdrawn in the United States and Europe but continues to be used in research. − …”

Magnetic Resonance Imaging as a Diagnostic Tool for Ilio-Femoro-Caval Deep Venous Thrombosis

“…Acute deep venous thrombosis (DVT) in the ilio-femoro-caval veins is an acute condition that requires fast and accurate detection and immediate treatment to avoid significant morbidity and mortality [ 1 , 2 , 3 , 4 ]. The typical clinical symptoms of DVT are pain in one leg, usually in the calf when walking or standing, and swelling in one leg as warm and red skin around the area in pain [ 3 ].…”

“…Different imaging possibilities for diagnosing DVT have been compared over recent years [ 1 , 2 , 4 , 6 , 8 , 9 , 10 , 11 , 12 , 14 , 15 , 16 ]. Typical studies compare the gold standard of catheter-directed thrombolysis with either CTV, ultrasound, or MRV.…”

“…A newer study by Aschauer et al examined 88 patients presenting clinical signs of deep vein thrombosis and/or pulmonary artery embolism of various stages. Excellent MR Angiography image quality was found in 87%, and a diagnostic image quality of MRV in 90% was observed, although not compared by diagnostic accuracy to other imaging modalities [ 4 ]. Not all evidence supports the replacement in favour of MRV, as Abdalla et al, in a systematic review, show a preference for an ultrasound to diagnose DVT, although suggesting MRV for obese patients [ 16 ].…”

“…Not all evidence supports the replacement in favour of MRV, as Abdalla et al, in a systematic review, show a preference for an ultrasound to diagnose DVT, although suggesting MRV for obese patients [ 16 ]. To our knowledge, former studies did include a limited number of patients (88 patients maximum) with only a few artery segments evaluated by two observers and often focused on both DVT and pulmonary artery embolism [ 1 , 2 , 4 , 6 , 8 , 9 , 10 , 11 , 12 , 14 , 15 , 16 ].…”